Comparative Evaluation Of Topical Preparations In Treatment of Melasma

p. 76

Roma Pandhi, I Kaur, S Handa

Fifty patients of melasma were randomly taken up for the study and were divided into five treatment groups of 10 patients each. Patients of these groups received clobetasol propionate 0.05% (group I), tretinoin 0.025% (group II), hydroquinone 2% (group III), bebzoyl peroxide 5% (group IV) and glycolic acid 10% (group V). Pretreatment evolution was done with MASI (melasma area severity index) scoring and photographic records. Patients were treated for 3 months and the preparations were found to be equally compatible to our patients. However, effectiveness on an average was higher for clobetasol (80%) and tretinoin (62%), though hydroquinone (48%), benzoyal peroxide (41%) and glycolic acid (30%) also showed fairly good results. Our study broadens the therapeutic spectrum of melasm by using agents with different mechanisms of action.

Nail involvement in pemphigus is relatively rare. A five year analysis of pemphigus cases admitted in our institute revealed 6 cases (15.6%) with nail involvement. Nail changes were part of the initial presentation along with skin and oral lesions in 4 cases, preceded mucocutaneous disease by months to year in one case and occurred with a relapse of pre-existing disease by months to year in one case and occurred with a relapse of pre-existing disease in another case. The nail dystrophy, periungual and subungual haematoma and proximal nail fold vesicles. All the patients responded well to dexamthasone cyclophosphamide pulse therapy.

Many Pigmented lesions of nonmelanocytic origin can mimic clinically melanocytic lesions including malignant melanoma. A histological interpretation by pathology is helpful in the diagnosis and management of these lesions. The cases during a two year period from January 1999 to December 2000 were reviewed to assess the prevalence of lesions with pigmented variants where histopathological examination helped to confirm/refute the clinical diagnosis. The most common lesion presented with such diagnostic difficulty clinically was seborrhoeic keratosis. Other lesions observed in the study included basal cell carcinoma (12), actinic keratosis (3) and dermatofibrosarcoma protuberans (3). The total number of cases studied was 26. Adherence to strict diagnostic criteria helped towards the correct diagnosis. As 50% of the lesions had pigmentation and 30% had a clinical diagnosis of melanoma, histopathologic evolution was crucial to avoid overdiagnosis of melanoma and to provide reassurance in benign lesions.

Histopathological Features Of Granulomatous Skin Diseases : An Analysis Of 22 Skin Biopsies

p. 88

Subhra Dhar, Sandipan Dhar

In the present study, skin biopsies were analysed for histopathological (HP) changes in 22 patients with various granulomatous dermatoses. In 6 specimens, HP features were diagnostic of BT leprosy, in 1 each of BB, BL and historid LL. The HP features were was lupus valugaris (LV) in 6 biopsies, tuberculosis verrucosa cutis (TBVC) in 2, sarcoidosis in 3 and sporotrichosis in remaining 2. The study reiterated the usefulness of HP examination of all suspected cases of granulomatous skin diseases.

Keloids are difficult to treat medically or surgically. Carbon dioxide (CO2) laser is considered to be a better therapeutic option due to less chances of recurrence with this modality. Fourteen patients, 4 males and 10 females, between 9 and 36 years of age having keloids for 1 to 10 years were included in this study. The lesions were present on chest, ear lobes, nape of neck, forearm, arm and shoulder. CO2 laser with a power setting of 10 to 20 watts was used in continuous mode to vaporize/excise the lesions. The patients were followed up at the end of last week, 2nd week and then every 4 weeks for 3 months to evaluate the response to treatment. Twelve patients followed up regularly and completed this study. Six patients with keliods on chest had 50 to 70% response. Remaining 6 patients with keliods on chest had 50 to 70% response. Remaining 6 patients with lesions on the ear lobes (3), showed 50 to 90% response. Nape of neck (1), shoulder, arm and forearm (2) lesions had 50 to 90% response. In all, except one patient the healing started by 4 weeks and complete healing of the treatment area occurred within 8 weeks. Four patients with poor response to CO2 laser alone were given in addition intralesional triaminolone acetonide 40mg/ml, which resulted in a better response in these patients. One patient had depigmentation of the treated area. There were no side effects in other patients. We therefore conclude that CO2 laser is a good therapeutic modality for the treatment of keloids: however recurrence on long term follow up needs to be observed.

A 50 year old lady presented with multiple pruritic fluid filled lesions all over the body of 5 years duration. Lesions healed with scarring and milia. Immunofluroescence confirmed the diagnosis of epidermolysis bullosa acquisita.

Hailey-Hailey disease is a benign familial chronic vesicobullous disease with unique histopathology. Four cases of this rare genodermatosis are reported here. All of them had the history of exacerbation in hot and humid weather.

A 48 year old male developed erythema on the face and neck with infiltrated papulo-plaque lesions on the neck region. A diagnosis of reticular erythematous mucinosis (REM) was made clinically and with the help of histopathology. Treatment which chloroquine and physical sunscreen gave a good therapeutic response within 8 weeks.

A 62 year old woman presented with widespread erythematous macules with lymphadenopathy and hepatosplenomegly of three months duration. Histology of Lymph node showed features of angioimmunoblastic lymphadenopathy.

Lichen striatus is an uncommon, self-limited, usually unilateral linear dermatosis of unknown aetiology. The lesions in two cases of lichen striatus, one on right cheek of a 7 year old boy for last 5 months and another on left arm of a 10 year old boy for last 3 months, exactly follow the pigmentary dermarcation lines: one, Pigmentary demarcation lines over the face (PDL-F) and the other Voigt-Futcher line (PDL-A). This observation might link between the linearity of lichen striatus and pigmentary demarcation lines.

When the scalp exhibits folds and furrows resembling gyri, it is termed as cutis vertices gyrata. The case reported was an eight year old girl who had cutis vertices gyrata localized to the occipital region of the scalp since birth. The underlying pathology was neurofibroma.

A 38 year old Nepalese man presented with a large red tender plaque on his back of 15 days duration. He had a history of fever, cough, chest pain and haemoptysis for 4 months. On examination, he also had pallor lymphadenopathy and hepatomegaly. Investigations revealed anaemia, marked leucocytosis with 45% atypical cells and thrombocytopenia. Chest X-ray showed consolidation and bone marrow examination revealed abnormal cells. Skin biopsy had features of cutaneous T-cell lymphoma (CTCL). We report this rare presentation of CTCL with simultaneous visceral and haematological involvement.

A 46 year old nondiabetic female presented with multiple, itchy lichenified papules localized over right lower leg. The histopathological findings were in accordance with granuloma annulare. The present case of localized popular type of granuloma annulare masquerading as a lichenified dermatosis forms a rare report.

Favus, although endemic in the Kashmir valley, is rarely reported form other parts of India. We report two cases of favus from rural Udaipur, Rajasthan, because of its rarity in a non- endemic zone. Both the patients had scutula and cicatricial alopecia, characteristic of scales. Culture on Sabouraudâ€™s dextrose agar grew Trichophyton schoenleinii in both the cases.

One case of lymphocutaneous sporotrichosis treated with itraconazole is reported here. Sporothix schenkii was isolated from the lesion and identity was confirmed by culture. The patient was treated successfully with oral administration of itraconazole 200 mg daily for 90 days.